The effects of covid-19 on tuberculosis case detection and treatment outcomes: analysis of routine tuberculosis program data in Dar es salaam region, Tanzania

Abstract

ABSTRACT Introduction Tuberculosis (TB) is a global health concern, causing significant morbidity and mortality worldwide. The COVID-19 pandemic has presented unprecedented challenges to the management of infectious diseases, including TB. The reprioritization of resources and the stigma associated with COVID-19 symptoms had the potential to disrupt TB diagnosis, treatment, and follow-up on care. This study aimed to assess the effects of COVID-19 on tuberculosis case detection and treatment outcomes in the Dar es Salaam Region of Tanzania. Methods This was a retrospective cohort study design, comparing two cohorts; the pre-COVID-19 era, February-July 2019, and the during the COVID-19 era, March-August 2020. Data sources were medical records of Tuberculosis patients from health facilities in Dar es Salaam and from the questionnaire to health facility in-charge or TB clinicians from the visited facilities. The study compared TB case detection and treatment outcomes between the pre-COVID-19 and during COVID-19 periods. The target population was all the notified TB cases in the health facilities in Dar es Salaam. A minimum of 1476 cases for each period was required to test the difference between the two periods. Data collection involved standardized data abstraction forms, capturing demographic information, clinical characteristics, treatment regimens, and outcomes, and a questionnaire that captured facility information related to COVID-19. Descriptive statistics, bivariate analyses, and multivariable logistic regression techniques were used in data analysis to determine the magnitude and factors for poor TB treatment outcomes. Results The results reveal that the overall proportion of missed TB cases during the pandemic was 13.5%. Females lost more cases, 21.1% (n=154) during COVID-19 compared to male counterparts (9.1%, n=114). Notification of TB cases among children was low during COVID-19, nearly by half of the cases, n=190 notified before COVID-19. In TB treatment outcomes, the overall results show a slight increase in the proportion of unfavorable treatment outcomes during the COVID-19 era, 5.4% (n=93) compared to the xiii pre-COVID-19 era, although the difference was not statistically significant (p=0.374). In the assessment of the factors, HIV status (positive), disease classification (Extra pulmonary TB Patients), and location (Kigamboni district) factors were found to prevail in both pre-and During the COVID-19 era as the factors for unfavorable TB treatment outcomes. Conclusion The COVID-19 pandemic had a significant impact on tuberculosis (TB) case detection. The variations were observed across districts, gender and type of TB patient referral, as observed in other countries. Also, the COVID-19 pandemic adversely affected TB treatment outcomes with increased unfavorable treatment outcomes such as mortality and loss to follow-up (poor adherence). The increased mortality and poor treatment adherence during the pandemic underscore the need for robust TB care and support systems, particularly during global health crises.